Foreign Material Investigation

Number: Department: Date: Shift: Line:

Time: Product: Found By/Title:

CHECK ONE: Missing tool or piece of piece of equipment Foreign Material

Foreign Material Event Description (what found, where, by who, other details - be specific!):

Investigation reminder: When determining the amount of product to retain and to aid in determining root cause, be sure to include in the inspection
all WIP product, rework, Flour systems, Mixing / extruders and shared equipment that may contain more foreign material or give insight into source.

Description of Material:

Size (mm): Sharp or Blunt: Type of Material:

Color: Shape: Other:

Ferrous (Magnetic): Non-Ferrous: Stainless Steel:

Was entire object accounted for (Yes/No)?

How much Code(s): If no product retained/discarded, why?

product was
retained (lbs)?

What was done with retained product?

How much Code(s): How was amount determined?

product was
discarded?

Is the source of the FM known? YES NO

If the source of the contamination was identified from within the facility's environment; WHO (name of person) has inspected the source to ensure it is
no longer introducing FM into the product?

Is there a specific procedure currently in the facility's written programs that clearly failed, thus resulting in FM being introduced into the products? If
yes, provide the details here.

Was sanitary condition restored (Yes/No)? Were procedures taken to ensure appropriate Were the established procedures reevaluated and
dispostion of products that may be contaminated? were there modifications?

Corrective Actions:

Supervisor: ___________________________________________________ Time/Date: ______________________________________

Food Safety Manager: ___________________________________________ Time/Date: ______________________________________

The records associated with this occurrence were reviewed and evaluated to determine if changes may be needed to the SSOPs to keep them current
and effective in respect to changes in facilities, equipment, utensils, operations, or personnel. Any repetitive corrective actions taken for problems with
the same cause were also evaluated to see if the SSOPs needed to be revised to prevent ongoing recurrence